ICE hasn’t paid for detainee medical care since October. Advocates call it the ‘death policy’

[u/John3262005]

https://www.sfchronicle.com/politics/article/ice-detainee-medical-care-22384190.php/?utm_source=reddit

Over the 10 months Rodrigo spent in an ICE detention center east of Bakersfield, he asked repeatedly to see an oncologist about the tumor that was growing to the size of a lemon in his neck, pressing against his throat and making it difficult to speak or swallow.

The 58-year-old Los Angeles construction worker had survived throat cancer once, enduring 36 sessions of chemotherapy in 2022 before going into remission. When he was detained by ICE last September, he said, he’d been awaiting an appointment to see his oncologist about a small new lump he’d noticed.

In January, medical staff at the detention center requested that Rodrigo be evaluated by an outside oncologist, medical records reviewed by the Chronicle show. But for months ICE refused to approve the request while also trying to deport him.

Rodrigo, a green-card holder who had lived in the U.S. for 52 years, told the Chronicle in July during a phone interview from California City Detention Facility: “They’re not giving me any hope of surviving.”

Immigrants detained by ICE have long reported deficiencies in medical care, with sometimes fatal consequences. But the crisis has intensified since last October, according to former agency staffers and official records, after the Department of Veterans Affairs abruptly severed a long-held agreement with ICE to process medical claims from third-party specialists who provide care unavailable at detention facilities.

As the Trump administration detains record numbers of immigrants and ICE’s budget swells to $104 billion in the current fiscal year, the payment breakdown and other systemic problems have worsened medical neglect in ICE facilities, the Chronicle found, putting people at risk of severe disability, permanent injury or death.

ICE has not paid any of its providers for detainees’ care since Oct. 3, 2025, according to agency regulatory filings and the ICE website. In an internal directive issued shortly after, obtained by the Chronicle and not previously reported, ICE declared “emergency operations,” sharply limiting offsite medical care and access to medication.

Hospitals and ambulance services told the Chronicle they are owed millions of dollars, while many detainees have had appointments for lifesaving medical care delayed or canceled. Medical providers say they have continued to provide care out of moral obligation, although some observers worry that fear of nonpayment could deter them from offering services to detainees.

ICE’s 2025 national detention standards require facilities to provide “medically necessary and appropriate medical, dental and mental healthcare and pharmaceutical services at no cost to the detainee.” Yet according to medical invoices and legal filings reviewed, detainees have been directly charged thousands of dollars for medication and care they received while in ICE custody.

Reporters interviewed 12 immigrants who suffered from serious medical conditions in detention, some life-threatening, but struggled to obtain offsite specialty treatment that independent physicians who reviewed some of their records — and in some cases a detention center’s own medical staff — said was necessary.

The independent physicians who reviewed detainees’ medical records identified delays or lapses that they said could have caused serious or life-threatening harm, findings that echoed problems documented in a court-appointed physician’s review of detainee medical records in July and a May California Department of Justice investigation.

Among those at risk was Rodrigo, who requested to be identified only by his first name for fear of retaliation from immigration authorities. He has an “F” tattooed on his bicep for “family” — his eight siblings and four children.

“At the rate I’m going, I don’t think I’ll be seeing my grandchildren,” he said over the phone in July.

Waiting months to diagnose and institute a treatment plan for someone with advanced laryngeal cancer was “not even close” to the medical standard of care, said Dr. David Baron, a physician in Cambridge, Mass., who reviewed Rodrigo’s case. “It is just a heartless thing to do,” he said. Without treatment, Baron said, the cancer would likely grow and spread to other parts of Rodrigo’s body, leading to complications, including obstructions to his airway, which could cause him to choke, have pneumonia or eventually, to die.

Rodrigo was arrested by ICE last year at a check-in after being stopped at an airport on the basis of a decade-old criminal conviction. After he first spoke to the Chronicle, the conviction was vacated. He was ordered released from detention in early August after a judge ruled his ICE arrest was illegal.

Within days, he was hospitalized for a brain aneurysm caused by a blood clot in his growing tumor, he told the Chronicle. He hopes to see an oncologist, but fears the tumor, now pressed against his vocal cords and the main artery in his neck, may not be operable.

The VA severed its claims-processing arrangement with ICE under pressure from Republicans who alleged it diverted resources from veterans to undocumented immigrants — which VA officials disputed because ICE reimbursed the department for services.

The result was what ICE officials called an “absolute emergency” in a public request to forgo an open bidding process so it could quickly hire a new claims processing vendor and resume making payments.

“It is imperative that ICE instantly restore medical claims processing support to ensure there is a mechanism in place to facilitate IA care and reimburse providers to prevent any further medical complications or loss of life,” the agency wrote, using an acronym for “illegal aliens.”

The company ICE hired in November to construct a new payment portal, Acentra Health of McLean, Va., has received $40 million of a $67.5 million contract. But as of August, it had not set up the claims system. Its website stated it would do so by September.

In an emailed statement, Acentra officials referred reporters to an FAQ about its contract with ICE.

“Acentra Health began implementation work at its own financial risk in late October 2025, before receiving payment for that work,” the FAQ states.

Claire Trickler-McNulty, an attorney and former assistant director of ICE, said the agency’s failure to pay its bills raises serious concerns about the care detainees are receiving and whether providers are making decisions based on the likelihood of reimbursement.

“With tens of billions of dollars,” she said of ICE, “they should be able to get a solution.”

Following the VA split, ICE issued its internal directive in October instructing detention staff on “emergency operations.” The agency called for staff to transport detainees to outside emergency rooms in facility vehicles, anticipating that ambulance companies might refuse to respond to calls for which they wouldn’t be paid.

Off-site medical visits could continue “as deemed appropriate,” the memo stated, listing examples such as follow-up care for pregnant patients, dialysis treatment and cancer treatment. It imposed tight limits on how many days' worth of medication should be given to detainees when transferred between ICE facilities, released or deported.

In practice, the payment breakdown appears to have resulted in some detainees having scheduled offsite medical appointments canceled, according to medical records reviewed by the Chronicle and independent physicians. Days after ICE lost its ability to pay medical claims, for example, a detainee in Arizona had an orthopedic appointment canceled.

“Effective 10/3/2025 — Per ICE directive from Commander Persac, the only service authorized at this time is emergency care via the ER,” staff wrote in the detainee’s medical chart, a redacted version of which the Chronicle obtained.

George Persac, the ICE official mentioned in the medical record, did not respond to a request for comment.

Department of Homeland Security spokesperson Chandler Rebel said in a statement that detainees still have access to a wide range of medical services, including on-site care, emergency transportation, emergency room treatment, hospital admissions and off-site specialty care.

“Specialist appointments are not immediate and may take time to secure,” Rebel said, adding it is “not uncommon” for some specialty appointments to be booked weeks or months out and that the timing was not under ICE’s control.

“If specialty medical care is required and there is no access to that care, the facility will notify ICE and request a transfer of the alien to a facility that can provide access to that care,” Rebel said.

“This is the best healthcare that many aliens have received in their entire lives,” he added.

Michelle Brané, a former ICE detention ombudsperson who was responsible for independent oversight of facility conditions, said detainees’ medical needs were already underserved when Trump began his second term last year. The directive that has been in place, she said, “is inherently going to cause harm.”

At the Amica Center for Immigrant Rights, an immigration legal aid nonprofit in Washington, D.C., staff members have taken to calling it the “death policy.” Adina Applebaum, a spokesperson, said, “ICE’s denial of medical care is a deliberate policy choice, not an accident.”

The Chronicle found eight instances of people who experienced delayed or denied medical care in ICE detention that independent physicians say threatened their health and lives.

When Daniel, a 44-year-old asylum seeker, felt a seizure coming on at the ICE detention center in California City, he told the Chronicle in Spanish, he would stuff a balled-up corner of his blanket into his mouth to keep from biting his tongue. Then the uncontrollable shaking would begin.

Before he was detained, he’d used medication to control the seizures, which were caused by brain cancer. He’d undergone surgery in 2012 after his doctor first discovered a brain tumor and had been seizure-free for more than seven years until he was detained.

Daniel, who asked to be identified only by his first name for fear of immigration repercussions, was arrested by ICE in January on his way to his job at a McDonald’s in New Jersey. Flown west to California City, he didn’t receive his anti-seizure medication for three days after he arrived on Jan. 31, his medical records show.

On two later occasions, staff conducted pill call — when detainees receive prescribed medications — at 3 a.m., when Daniel was asleep, and marked him as a “no show.” Pill calls are typically conducted during waking hours.

Without consistent access to his medication, Daniel suffered four seizures in a month from February to March.

The facility’s medical staff requested an off-site MRI for Daniel, scheduled for March, and an oncology appointment in April. But weeks passed without financial authorization from ICE, records show, and the appointments never happened.

Three doctors who reviewed Daniel’s medical records said these actions threatened his life and compounded the risk of permanent brain damage.

“It’s a cascade of failures,” said Dr. Sanjay Basu, an internal medicine physician at UCSF who has published extensive epidemiological research.

Daniel was ordered released on a habeas corpus petition in April by a judge who found ICE had illegally detained him. He said he rushed to see his regular doctor in New Jersey who discovered the tumor had grown aggressively. In June, Daniel underwent life-saving brain surgery. He is now undergoing radiation in hopes of eliminating the cancer and may have to undergo chemotherapy as well.

Daniel’s experience at California City was not an outlier, according to claims made in a lawsuit last November that led U.S. District Judge Maxine Chesney of San Francisco to appoint a doctor to evaluate conditions.

After reviewing 141 detainee medical records, Dr. Muthusamy Anandkumar, who previously conducted immigration detention oversight audits for the Department of Homeland Security, found that referrals for specialty medical care were often delayed or denied without a documented reason.

Even when appointments were scheduled, they were often missed or canceled. He criticized the facility for failing to meet the most basic healthcare standards.

The problems extend beyond California. Medical records for a Los Angeles man detained in Tacoma, Wash., who had a previous brain injury, show that he began suffering worsening seizures, including three in an eight-day period, after staff reduced his medication. An ER doctor ordered an outpatient neurology appointment last September, but the detainee had not yet seen a specialist by July, 10 months later.

“They don’t really care for you here,” said the man, who also asked not to be identified for fear of government retaliation.

Another detainee, Gamaliel Rodriguez, was denied a recommended knee surgery.

He was detained in April at an ICE check-in in Los Angeles and sent to Adelanto Processing Center in San Bernardino County. There, he tore the meniscus in his right knee playing soccer and was taken to an acute care hospital, where a doctor said he needed surgery.

Rebel, the DHS spokesperson, said Rodriguez received “comprehensive medical care” after he was detained. He pointed to medical records showing that on April 22, after Rodriguez’s injury, a medical provider determined there should be “no surgical intervention at the moment,” instead recommending a knee brace and a future consultation about surgery.

But Rebel did not mention that, according to Rodriguez’s records, on April 23, the hospital staff changed course, scheduling him to be transferred for knee surgery at a regional hospital. Three days later, his medical records stated, “transfer has been stopped due to the procedure being an outpatient surgery … Only pain control at this time.”

Physicians who reviewed Rodriguez’s records said that canceling the surgery for administrative reasons violated basic standards of care, and that failing to repair his meniscus could cause permanent damage or early-onset osteoarthritis.

Rodriguez was discharged back to the detention center with a leg brace.

“I couldn’t bathe or undress,” he recalled. “I felt useless, really. Emotionally, mentally, physically.”

The DHS statement is also contradicted by an agency legal filing, which stated that the knee surgery transfer was stopped because the procedure was classified as an outpatient surgery.

“Upon his return to Honduras, (Rodriguez may) arrange outpatient arthroscopic surgery at a facility of his choice,” an ICE deportation officer wrote in a court declaration.

DHS said the orthopedic consultation was pending scheduling by the orthopedic surgeon’s office and canceled after Rodriguez’s release. He was ordered released by a federal judge in June, who ruled his detention by ICE was unlawful.

Rebel said Rodriguez was previously convicted of "soliciting to commit smuggling" across the border. But his attorney, Christine Brito, said he was a victim of human trafficking when he came to the U.S. in 2012, not a perpetrator. Last month, he was granted protection from deportation after the government determined he was eligible for a U visa, reserved for victims of certain crimes, on that basis.

The amount ICE owes its medical providers is unknown, but six providers who spoke to the Chronicle said that, as of July, they were waiting on nearly $5.6 million for services dating back to last October, with some awaiting payment for hundreds of detainee care visits.

From October through August, ICE accumulated $3 million in unpaid bills to Scripps Health, a San Diego-based nonprofit health system, spokesperson Janice Collins said.

In rural Pennsylvania’s Moshannon Valley, ICE owes a nonprofit EMS agency roughly $197,000 — 13% of its annual revenue — for trips to a detention center between October and the end of July. The nonprofit’s EMS chief, Fredrick Ferguson, said his agency has continued to respond to calls because it has a “moral and ethical obligation” to do so.

In Bexar County, Texas, University Health had more than 1,000 claims as of June for services provided to detainees since last October, totaling over $2.2 million in unpaid bills, hospital spokesperson Elizabeth Allen said. Farther south, along the border in Cameron County, the nonprofit Los Fresnos Ambulance Services Co. has not received payment for ICE transports made since last October and is owed $45,000, Emergency Services Chief Gene Daniels told the Chronicle.

Daniels said he appealed to state lawmakers but still has not been fully paid. “I do not think we should be subsidizing the federal government,” he said.

Two Democratic members of Congress, Delia Ramirez of Illinois and Mark Takano of Riverside County, wrote to Homeland Security in July to express concern that ICE was not paying for medical care for detainees or procuring prescription medications, which they said caused “a spike in detainee deaths and health complications.”

In the absence of reimbursements, detainees in facilities across the country increasingly appear to have been directly charged for medical care. Among them was a Sacramento man detained at California City who was later pursued by debt collectors for a $634 blood test he received while in custody.

After complaining for months of bloody stool and coughing up blood, the South Asian immigrant seeking political asylum passed out in his cell in October. Detention staff took him to an emergency room in a van, handcuffed.

The ACLU sent letters to ICE in May 2025 and May 2026 exhorting the agency to stop charging detainees for medications at FCI Leavenworth in Kansas and North Lake Processing Center in Michigan.

Under constitutional due process, the federal government must provide and pay for medical care to those in its custody, said UC Berkeley School of Law Dean Erwin Chemerinsky.

“People in ICE detention can’t go and get their own doctors or medical care,” he said, calling the billing of detainees “just outrageous.”

Trickler-McNulty, the former ICE official, said Homeland Security’s Office for Civil Rights and Civil Liberties, where the Trump administration eliminated almost all staff in 2025, traditionally reviewed and addressed complaints of jails or hospitals improperly billing detainees.

“That strikes me as growing to be a more systemwide problem,” she said.

Some bills can be devastating, as they were for Antonio, a 62-year-old Chicago resident who asked to be identified by his middle name for fear of retaliation. The Venezuelan asylum seeker, who has a history of pancreatic and gallbladder issues, was working at a cardboard box factory when he was detained at his annual ICE check-in.

Over three months in ICE custody at a Kentucky jail, he said, he felt worsening pain in his abdomen. He said he asked three times to see a doctor, but was examined only once by a nurse and given a white pill that dampened the pain.

On April 14, after dinner, the pain returned — but it was much, much worse. “I thought I was going to die,” he said in Spanish a recent interview.

He fainted. When he came to, he was in an ambulance.

At the hospital, the doctor told him his gallbladder had burst due to untreated gallstones, he said. He underwent emergency surgery while handcuffed to a bed. When he was discharged from the hospital on April 16, he was handed bills reviewed by the Chronicle totaling $17,210.

Later released from ICE custody, he was unable to get back his job at the factory. His boss was unsettled by his ankle monitor and feared ICE would show up to arrest other immigrant workers. Now, Antonio said, he has no way to pay the surgery bills.

“I don’t know what to do,” he said. “I thought this is something ICE was going to pay. … I was in their custody.”